In adults with normal renal function undergoing major noncardiac surgery, 0.8% developed acute renal failure, driven by preoperative comorbidities and intraoperative vasopressor and diuretic use.
Observational (n=15,102)
No
What are the preoperative and intraoperative predictors of postoperative acute renal failure after major noncardiac surgery in patients with previously normal renal function?
In patients with normal baseline renal function undergoing major noncardiac surgery, acute renal failure occurs in 0.8% of cases and is associated with specific preoperative comorbidities and intraoperative use of vasopressors and diuretics.
p-value: p=<0.05
BACKGROUND: The authors investigated the incidence and risk factors for postoperative acute renal failure after major noncardiac surgery among patients with previously normal renal function. METHODS: Adult patients undergoing major noncardiac surgery with a preoperative calculated creatinine clearance of 80 ml/min or greater were included in a prospective, observational study at a single tertiary care university hospital. Patients were followed for the development of acute renal failure (defined as a calculated creatinine clearance of 50 ml/min or less) within the first 7 postoperative days. Patient preoperative characteristics and intraoperative anesthetic management were evaluated for associations with acute renal failure. Thirty-day, 60-day, and 1-yr all-cause mortality was also evaluated. RESULTS: A total of 65,043 cases between 2003 and 2006 were reviewed. Of these, 15,102 patients met the inclusion criteria; 121 patients developed acute renal failure (0.8%), and 14 required renal replacement therapy (0.1%). Seven independent preoperative predictors were identified (P < 0.05): age, emergent surgery, liver disease, body mass index, high-risk surgery, peripheral vascular occlusive disease, and chronic obstructive pulmonary disease necessitating chronic bronchodilator therapy. Several intraoperative management variables were independent predictors of acute renal failure: total vasopressor dose administered, use of a vasopressor infusion, and diuretic administration. Acute renal failure was associated with increased 30-day, 60-day, and 1-yr all-cause mortality. CONCLUSIONS: Several preoperative predictors previously reported to be associated with acute renal failure after cardiac surgery were also found to be associated with acute renal failure after noncardiac surgery. The use of vasopressor and diuretics is also associated with acute renal failure.
Kheterpal et al. (Sat,) conducted a observational in Postoperative acute renal failure (n=15,102). Preoperative comorbidities and intraoperative vasopressor or diuretic use vs. Absence of these risk factors was evaluated on Acute renal failure (calculated creatinine clearance ≤50 ml/min) within the first 7 postoperative days (p=<0.05). In adults with normal renal function undergoing major noncardiac surgery, 0.8% developed acute renal failure, driven by preoperative comorbidities and intraoperative vasopressor and diuretic use.